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Questions and Answers
What percentage of Australian children aged 6-14 had dental caries in their permanent teeth?
What is the main cause of dental caries?
What can happen if dental caries is left untreated?
What is the name of the condition where bacteria in the plaque produce acid that demineralizes the tooth structure?
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Why do people often visit pharmacies instead of dentists?
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What is the name of the condition where the jawbone dies due to medication?
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When can dental caries occur?
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What is the consequence of untreated tooth loss?
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What is the primary purpose of 'deep cleaning' in dentistry?
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What is the precursor to periodontitis?
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What is the recommended treatment for gingivitis?
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What is alveolar osteitis?
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What is the incidence of MRONJ in patients with metabolic bone disease?
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What is the pathogenesis of alveolar osteitis?
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What is the recommended treatment for alveolar osteitis?
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Why is counseling important for patients taking bisphosphonates?
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What is the recommended duration for an ulcer to last before advising further action?
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What is the name of the viral illness that causes painful ulcers in the mouth, often in the back of the throat and roof of the mouth?
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What is the name of the disease that is accompanied by small oval blisters on the palms and soles of feet?
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What is the term for the stage that precedes the appearance of lesions in Herpes Simplex Labialis?
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What is the name of the virus that causes Herpes Simplex Labialis?
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What is the role of hygiene in preventing fungal infections?
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What is the type of organism that causes oral candidiasis?
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What is the course of action for fungal infections?
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What could be a sinister outcome if an intra-oral white lesion is not removed?
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Which of the following is NOT a cause of dry mouth?
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What can chronic dry mouth contribute to?
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What is a recommended treatment for dry mouth?
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Why should teething gels not be used?
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What is a common concern for edentulous patients?
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What can be offered to patients with denture concerns?
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What is a potential cause of denture concerns?
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What is the primary cause of bone loss around the teeth in Periodontitis?
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What is the recommended treatment for a fractured tooth?
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What is the proportion of adults with moderate or severe Periodontitis in 55-74 year olds?
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What is the relationship between Periodontitis and type 2 diabetes?
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What is the maximum dose of Paracetamol recommended for pain relief?
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What is the consequence of untreated Periodontitis?
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What is the recommended dosage of Ibuprofen for pain relief?
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What is the common symptom of a fractured tooth?
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Study Notes
Dental and Oral Health
- Conditions concerning the hard tissues of the oral cavity (teeth, bones)
- Conditions concerning the soft tissues of the oral cavity (everything aside from teeth and bones)
- Issues concerning patients with no teeth (paediatrics and geriatrics)
- Items found in the oral health section of community pharmacies
Dental Caries
- What: Holes in teeth, also known as cavities
- When: As soon as teeth erupt (can be in primary dentition, i.e., baby teeth, or permanent dentition, i.e., adult teeth)
- Why: When dental plaque adheres to the surface of teeth and is not removed for a substantial period of time, bacteria (predominantly Streptococcus mutans) adhere to the plaque and produce an acid that demineralizes the tooth structure
- Prevalence: Around 1 in 4 (24%) Australian children aged 6-14 had dental caries in their permanent teeth, around 1 in 10 (11%) had at least one permanent tooth with untreated decay
Effect of Dental Caries and Treatment
- Painful, causing sensitivity, pain, and in some cases, severe pain
- Untreated may lead to tooth loss (extraction) which has broader consequences (poor mastication, speech, dysphagia, ongoing problems with nutrition)
- Untreated may infect the pulp chamber leading to a spreading infection with sometimes fatal consequences (e.g., Ludwig's angina, cavernous sinus thrombosis)
- Treatment: Requires a dentist; tooth may be restored; root canal treatment may be necessary or extraction
- Supply of analgesics to temporize until patient sees a dentist (Paracetamol (4g max) and Ibuprofen (2.4g max), generally 1TDS of each)
Fractured Teeth/Cracked Tooth Syndrome
- Patients present with vague symptoms, poorly localized, episodic, pain on chewing/biting
- Fractures of teeth are the third most common cause of tooth loss in industrialized countries
- Generally, patients don't know their teeth are fractured
- Supply of analgesics to temporize until patient sees a dentist (Paracetamol (4g max) and Ibuprofen (2.4g max), generally 1TDS of each)
Periodontitis
- What: Inflammation of the ligaments attaching the tooth to bone leading to bone loss around the teeth
- When: Takes time to advance to level of bone loss, begins as gingivitis and progresses when left untreated
- Why: Foreign body stuck to teeth, bacterial attachment, localized inflammation (cytokines, matrix metalloproteinases) leading to bone loss
- Relation to type 2 diabetes: Have a relation to type 2 diabetes; if the patient gets diagnosed with type 2 diabetes, recommend the patient to get checked on their teeth
- Effect of Periodontitis and Treatment
- Painful, causing sensitivity, pain, and in some cases, severe pain
- Untreated may lead to tooth loss (extraction) which has broader consequences (poor mastication, speech, dysphagia, ongoing problems with nutrition)
- The proportion of adults with moderate or severe periodontitis increased with age, ranging from 12% in 15-34 year olds, 33% in 35-54 year olds, 51% in 55-74 year olds and 69% in those aged 75 years and over in 2017-18 (AIHW 03/2021)
- Bidirectional relationship with type 2 diabetes - the presence of one makes the other worse
- Treatment: 'Deep cleaning' is performed to remove plaque and calculus from beneath the gums; patients will present in pain and sometimes with mobile "wobbly" teeth; supply analgesics as well as chlorhexidine mouthwash TDS for 2 weeks + referral to dentist
Gingivitis
- Inflammation of the gums can be generalized or localized
- Precursor to periodontitis
- Can be treated with improved oral hygiene and professional dental prophylaxis (scale and clean)
- Advise patients to brush twice daily as well as chlorhexidine mouthwash (e.g., Savacol) for 2 weeks
Alveolar Osteitis (Dry Socket)
- What: Localized painful inflammation of the bone surrounding the extraction socket following premature loss/breakdown of the blood clot
- When: Complicates approximately 5% of extractions
- Why: Pathogenesis is poorly understood; mostly secondary to smoking, excessive spitting; patients who have T2D, take the OCP, are female, and older age are likely to experience this
- Treatment: Self-limiting, analgesics, and saline/chlorhexidine irrigation; supply analgesics to temporize until patient sees a dentist (Paracetamol (4g max) and Ibuprofen (2.4g max), generally 1TDS of each)
MRONJ - Medication-Related Osteonecrosis of the Jaw
- What: Exposed bone in the maxilla or mandible that has been present for more than 8 weeks following tooth extraction
- When: In patients who are taking bisphosphonates, anti-resorptive or anti-angiogenic medication
- Incidence: 1% in cancer patients and 0.1% in patients with metabolic bone disease
- Why: Inhibition of osteoclastic bone resorption and remodeling; existing inflammation and infection from teeth that were removed; inhibition of angiogenesis (formation of new blood vessels)
- Treatment: Counsel patients prior to starting anti-resorptive and anti-angiogenic medication, and advise them to see their dentist; ensure to advise that ulcers should not last for longer than 2 weeks (epithelial turnover time)
Infective Ulcers
- Ulcers secondary to bacterial, viral, or fungal infection
- Examples secondary to viral infection: Herpangina, Hand, Foot and Mouth Disease (HFMD)
- Treatment: Managing pyrexia, symptomatic relief for ulcers (also mention a bland diet - cold milk, ice cream, avoid spicy foods)
Cold Sores (Herpes Simplex Labialis)
- What: Recurrent oral mucocutaneous herpes simplex virus (HSV) infection follows latent activation of the virus
- Where: Lesions usually occur on the lips but can also occur on the intraoral mucosa or other areas of the skin
- When: Lesions usually preceded by the prodromal stage, lasting several hours to days, which features pain, burning, tingling, or itching
- Recurrences are usually mild and infrequent; frequency can be minimized with sun protection
Fungal Infections
- What: Candida species are commensal organisms of the oral cavity; oral candidiasis is an opportunistic infection that is uncommon in healthy individuals
- Why: Hygiene is important
- Referral is necessary (either dentist or GP); intra-oral white lesions may be much more sinister and require further investigation
Dry Mouth
- What: May be the subjective sensation (xerostomia) or there may be a pathological problem (salivary hypofunction)
- Why: Dehydration, alcohol, anxiety, mouth breathing, drugs (generally the "anti" drugs - anticholinergics, antihistamines, antihypertensives, antidepressants, antipsychotics, as well as opioids, inhaled bronchodilators)
- Chronic dry mouth may contribute to tooth decay, periodontal disease, oral candidiasis, difficulty retaining dentures, difficulty chewing, swallowing, speech, and altered sense of taste
- Relevance: Counsel about the possibility of this happening where relevant, any alternative medications; ensure adequate hydration, drinking water regularly; products that stimulate saliva, such as lozenges, chewing gum; artificial salivary products, e.g., Biotene; referral to determine cause!
Edentulous Patients - Paediatrics and Geriatrics
- Teething: Tooth eruption generally accompanied by pain, swelling, drooling, irritability
- Treatment: Teething gels should not be used because of the lack of evidence of efficacy and the potential for harm; cold cucumbers; teething rings; rubbing the gums with a clean finger
Denture Concerns
- Loose dentures
- Irritating dentures (sharp, large, uncomfortable)
- Potential causes: May have been made incorrectly, old, broken, underlying pathology causing mucosal changes
- Dirty dentures
- Relevance: Can offer polydent (or other) products - self-use adhesive products as well as denture cleaners
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Description
Quiz about dental and oral health conditions, including those affecting hard and soft tissues, and pharmacy practice related to oral health.
